Reference values for lipid profile in Iranian children and adolescents: the CASPIAN-V study.

BACKGROUND: We aimed to develop the age- and sex-specific reference values for lipid profile of Iranian pediatric population. METHODS: Fasting lipid profiles of 3843 participants, aged 7 to 18 years, were extracted from a surveillance survey on Iranian children and adolescents living in 30 provinces across the country. RESULTS: The mean (SD) age of participants was 12.3(3.1) years, and 52.3% of them were boys. Significant differences were observed between genders comparing the levels of triglyceride (TG) (P = 0.04), total cholesterol (TC) (P = 0.02), low-density lipoprotein- cholesterol (LDL-C) (P = 0.01), and non-high-density lipoprotein cholesterol (non-HDL-C) (P = 0.03). In both genders, TG levels increased with age in the 75th and higher percentiles. Among boys, TC showed a decreasing trend at all percentiles and all age groups. In girls, TC levels increased with age at all percentiles except for the 75th and 90th percentiles. Among boys, the levels of LDL-C and HDL-C decreased with age in all percentiles. However, LDL-C and HDL-C concentrations increased up to the 50th percentile in girls and then decreased with age. The non-HDL-C level decreased in the 50th and higher percentiles among boys and in the 90th and 95th percentiles among girls. The TG/HDL-C ratio increased with age at all percentiles in boys. In girls, TG/HDL-C ratio increased with age in the 50th and higher percentiles. CONCLUSIONS: Based on the observed differences, it seems necessary to determine age- and sex-specific cut-off values for lipid parameters of children and adolescents in different populations.

Level of physical activity and screen time among Iranian children and adolescents at the national and provincial level: The CASPIAN-IV study.

Background: There are few epidemiological reports on adherence to physical activity (PA) and screen-time (ST) recommendations among Iranian children and adolescents at the provincial level. We used nationally representative data to provide recent prevalence estimates of Iranian children who met the recommendations for PA and ST. Methods: This nationwide study was conducted among 14,880 students aged 6-18 years from 30 provinces of Iran. The frequency of the recommended level for PA (>1 hours/week) and ST (<2 hours/day) and different combinations of PA and ST was determined in the studied population. Results: In this study, 13,486 students (response rate: 90.6%) were studied. Overall, 18.62%, 34.11%, 50.66% and 9.63% of the students reported high ST, low level of PA, high TV watching and high computer working, respectively. The frequency of the recommended level of PA and ST was 53.92%. Of the studied population, 6.63% had low PA and high ST. Paradox combinations of low PA and low ST and moderate/high PA and high ST was prevalent among 27.47% and 6.26% of the children and adolescents. The lowest and highest frequency of recommended level of PA and ST was 38.9% and 65%, respectively. The lowest and highest frequency of low PA and high ST was 1.87% and 13.77%, respectively. Conclusion: The results of this study revealed that the frequency of low PA was high and that approximately 46% of the students did not meet the recommended level of PA and ST. The findings indicated that preparing facilities for improving PA level among children should be the main priority in our future interventions in this field.

Percentile values for serum levels of vitamins A and D in Iranian children and adolescents: The CASPIAN-V study.

OBJECTIVES: The reference values to determine vitamin A and D deficiency may vary based on ethnicity, age, and region of residence. The aim of this study was to determine the reference interval of circulating vitamin A and D levels among Iranian children and adolescents based on sex, age, and region of residence. METHODS: This nationwide cross-sectional study was performed with 2596 students 7 to 18 y of age from the CASPIAN-V (Childhood and Adolescence Surveillance and Prevention of Adult Non- communicable disease) study. A parametric method was used to define the age-specific reference values by obtaining smooth centile curves and explicit formulae for the centile estimates and SD scores for both sexes and regions of residence. RESULTS: Significant differences were found between the residents of rural and urban regions in terms of serum 25-hydroxyvitamin D [25(OH)D] and retinol concentration (P < 0.05). Boys (27 ± 8 versus 26.04 ± 10, P = 0.009). Children ages 7 to 12 y had higher serum 25(OH)D concentration than 13- to 18-y-old adolescents (26.96 ± 8 versus 26.04 ± 10, P = 0.007). The estimated reference interval for circulating 25(OH)D levels corresponding to the range between the 5th and 95th percentiles were 11.45 to 48.40 ng/mL in boys and 9.51 to 47.69 ng/mL in girls. Estimated reference intervals for serum retinol concentration among boys and girls corresponding to the 5th and 95th percentiles were 0.58 to 3.38 and 0.58 to 4.52, respectively. There were significant variations in both retinol and 25(OH)D concentrations across different age groups. CONCLUSION: This study established the reference intervals for circulating 25(OH)D and retinol levels in Iranian adolescents and children in different age groups based on sex and region.

A systematic literature review of observational studies of the bilateral association between diabetes and migraine.

BACKGROUND AND AIM: To conduct a systematic literature review and synthesize data from all epidemiological studies investigating the association between diabetes and migraine in adults. METHOD AND MATERIAL: Electronic databases, including Web of Science, PubMed and Scopus in addition to Google Scholar search engine were systematically searched up to Jun 2020 to identify studies reporting the diabetes-migraine association. RESULTS: A total of 15 studies were selected which were published from 2012 to 2019. Five out of 15 studies assessed the presence of migraine in diabetic subjects, while nine studies assessed the presence of diabetes in migraine subjects. The cohort study reported a hazard ratio for diabetes of 1.06 (95% confidence interval (CI): 0.91-1.24) for women with migraine with aura, 1.01 (95% CI: 0.89-1.16) for women without aura, and 1.13 (95% CI: 0.98-1.3) for women with a migraine history, compared with women with no history of migraine. Due to the high degree of heterogeneity, and the lack of statistical estimates of the association in several of the reviewed studies, meta-analysis of the available data was not possible. CONCLUSION: This study is the first review to examine the association between diabetes and migraine. Further longitudinal studies are required to clarify the migraine-diabetes association. There is also a clear need for more studies with larger sample sizes and similar methodologies in order to provide necessary information to conduct a meta-analysis.

Safety and efficacy of Favipiravir in moderate to severe SARS-CoV-2 pneumonia.

BACKGROUND: We examined the safety and efficacy of a treatment protocol containing Favipiravir for the treatment of SARS-CoV-2. METHODS: We did a multicenter randomized open-labeled clinical trial on moderate to severe cases infections of SARS-CoV-2. Patients with typical ground glass appearance on chest computerized tomography scan (CT scan) and oxygen saturation (SpO2) of less than 93% were enrolled. They were randomly allocated into Favipiravir (1.6 gr loading, 1.8 gr daily) and Lopinavir/Ritonavir (800/200 mg daily) treatment regimens in addition to standard care. In-hospital mortality, ICU admission, intubation, time to clinical recovery, changes in daily SpO2 after 5 min discontinuation of supplemental oxygen, and length of hospital stay were quantified and compared in the two groups. RESULTS: 380 patients were randomly allocated into Favipiravir (193) and Lopinavir/Ritonavir (187) groups in 13 centers. The number of deaths, intubations, and ICU admissions were not significantly different (26, 27, 31 and 21, 17, 25 respectively). Mean hospital stay was also not different (7.9 days [SD = 6] in the Favipiravir and 8.1 [SD = 6.5] days in Lopinavir/Ritonavir groups) (p = 0.61). Time to clinical recovery in the Favipiravir group was similar to Lopinavir/Ritonavir group (HR = 0.94, 95% CI 0.75 - 1.17) and likewise the changes in the daily SpO2 after discontinuation of supplemental oxygen (p = 0.46) CONCLUSION: Adding Favipiravir to the treatment protocol did not reduce the number of ICU admissions or intubations or In-hospital mortality compared to Lopinavir/Ritonavir regimen. It also did not shorten time to clinical recovery and length of hospital stay.

Percentile values of serum zinc concentration and prevalence of its deficiency in Iranian children and adolescents: the CASPIAN-V study.

Background To determine the prevalence of serum zinc deficiency and provide the age- and sex-specific percentile values of serum zinc in children and adolescents. Methods We used the gathered data through the CASPIAN-V study, a national survey conducted on 3500 students aged 7-18 years from 30 provinces of Iran. In this study, 1370 blood samples were selected randomly, and serum zinc concentration was measured using a Hitachi automated analyzer. Zinc deficiency was defined as a serum zinc level of less than 75 µg/dL. Age-sex specific reference percentile values were developed for serum zinc concentration. Results The mean age of participants was 12.4 ± 3.0 years; 49.3% were girls and 73% were urban inhabitants. Mean (standard deviation [SD]) of serum zinc concentration was 107.23 (25.81) µg/dL with a significant sex difference; 109.03 ± 26.12 µg/dL for males compared to 105.41 ± 25.3 µg/dL for females (p = 0.009). The prevalence of subclinical zinc deficiency was 4.9% (95% confidence intervals [CI]: 3.0, 6.9) in children and adolescents. Both zinc deficient and sufficient groups were similar in terms of age, sex and residential areas (all p-value > 0.05). Overall, the 5th and 95th percentile values for serum zinc were 68.28 and 151.87 µg/dL, respectively. The value of all percentiles consistently decreased with age. The 10-99th percentile values for serum zinc were greater in boys than girls at all ages. Conclusions Nearly 5% of subjects had zinc deficiency. Age-sex specific percentile values were established for Iranian children and adolescents.

Metabolic syndrome and its components among women with polycystic ovary syndrome: a systematic review and meta-analysis.

Introduction: The objectives of this study were to provide an estimate of the prevalence of metabolic syndrome (MetS ) and its components among women with PCOS; and calculate the odds ratio (OR) for MetS (using different definitions of MetS) in women with PCOS, compared to healthy controls. Methods: All of the relevant databases were used to search for appropriate articles that were published during the period 2003-2016. We included observational studies (cross-sectional, comparative cross-sectional) among women who met the inclusion criteria. The random-effect models were used to pool the prevalence of MetS and its components among PCOS women. This model was also applied to the pooled OR assessing the association between MetS and PCOS. Results: The pooled prevalence of MetS among PCOS women was found to be 26.30% (95% CI: 23.68-28.93), but varied from 7.10% (95% CI: 1.64-12.56) to 37.50% (95% CI: 28.84-46.16), depending upon the diagnostic criteria used. Low high-density lipoprotein cholesterol (HDL) - 61.87% (95% CI: 53.31-70.43) and high waist circumference (WC)- 52.23% (95% CI: 43.84-60.61) were the most common components of MetS in PCOS women. Compared to healthy controls, the overall pooled (OR) of MetS in PCOS patients was 2.09 (95% CI: 1.67-2.60), but this ranged from 0.31 (95% CI: 0.13-0.74) to 4.69 (95% CI: 2.09-10.52), depending upon the diagnostic criteria used. Conclusion: Women with PCOS had a much higher prevalence of MetS than was found among the healthy controls. Furthermore, as low HDL and high WC were the most common components of MetS in PCOS women, these two components specifically need to be addressed in prevention strategies.

Metabolic syndrome and its components in premenopausal and postmenopausal women: a comprehensive systematic review and meta-analysis on observational studies.

OBJECTIVES: To perform a meta-analysis on the global prevalence of metabolic syndrome (MetS) in postmenopausal women. The meta-analysis also sought to measure the relationship menopause status has with MetS and its components. METHODS: The Web of Science, Medline, PubMed, Scopus, Embase, CINAHL, DOAJ, and Google Scholar were all searched using the relevant keywords. Articles published during the period 2004 to 2017 that met our inclusion criteria and reported the prevalence of MetS among premenopausal and postmenopausal women were included. In the presence of heterogeneity, random-effects models were used to pool the prevalence and odds ratios (ORs), as measures of association in cross-sectional and comparative cross-sectional studies, respectively. RESULTS: The prevalence of MetS among postmenopausal women (119 studies [n = 95,115]) and the OR comparing the prevalence of MetS among postmenopausal and premenopausal women (23 studies [n = 66,801]) were pooled separately. The pooled prevalence of MetS among postmenopausal women was found to be 37.17% (95% confidence interval [CI] 35.00%-39.31%), but varied from 13.60% (95% CI 13.55%-13.64%) to 46.00% (95% CI 1.90%-90.09%), depending upon the diagnostic criteria used. The overall pooled OR for MetS in postmenopausal women, compared with premenopausal women, was OR 3.54 (95% CI 2.92-4.30), but this ranged from OR 2.74 (95% CI 1.32-5.66) to OR 5.03 (95% CI 2.25-11.22), depending upon the criteria used. Furthermore, the odds of high fasting blood sugar (OR 3.51, 95% CI 2.11-5.83), low high-density lipoprotein cholesterol (OR 1.45, 95% CI 1.03-2.03), high blood pressure (OR 3.95, 95% CI 2.01-7.78), high triglycerides (OR 3.2, 95% CI 2.37-4.31), and high waist circumference (OR 2.75, 95% CI 1.80-4.21) were all found to be higher in postmenopausal women than in premenopausal women. CONCLUSIONS: The prevalence of MetS is relatively high in postmenopausal women and was more prevalent among postmenopausal than premenopausal women. Menopausal hormone therapy should be used with caution in patients with MetS, as its safety has not yet been evaluated among MetS patients and meticulous evaluation of each individual patient before starting MHT is needed.

Metabolic syndrome and its components among rheumatoid arthritis patients: A comprehensive updated systematic review and meta-analysis.

BACKGROUND: Estimating the current global prevalence of metabolic syndrome (MetS), and its components, among rheumatoid arthritis (RA) patients is necessary in order to formulate preventative strategies and to ensure there are adequate community resources available for these patients. Furthermore, the association between RA and MetS is controversial and has not previously been comprehensively assessed. Therefore, the present study aimed to: 1) determine the prevalence of MetS, and its components, among RA patients across the world 2) update the odds ratio of MetS in RA patients, compared to healthy controls, using a comprehensive systematic review and meta-analysis. METHODS: International databases, including: the Web of Science, PubMed, Scopus, Embase, CINAHL and other relevant databases were searched to identify English language articles which reported the prevalence and risk of MetS in RA patients between January 2000 and August 2016. The meta-analysis only included studies which clearly described the time and location of the study, utilised adequate sampling strategies, and appropriate statistical analyses. RESULTS: The meta-analyses of prevalence (70 studies [n = 12612]) and risk (43 studies [n = 35220]) of MetS in RA patients were undertaken separately. The overall pooled prevalence of MetS was 30.65% (95% CI: 27.87-33.43), but this varied from 14.32% (95% CI: 10.59-18.05) to 37.83% (95% CI: 31.05-44.61), based upon the diagnostic criteria used. The prevalence of MetS also varied slightly between males (31.94%, 95% CI: 24.37-39.51) and females (33.03%, 95% CI: 28.09-37.97), but this was not statistically significant. The overall pooled odds ratio (OR) of MetS in RA patients, compared to healthy controls, was 1.44 (95% CI: 1.20-1.74), but this ranged from 0.70 (95% CI: 0.27-1.76) to 4.09 (95% CI: 2.03-8.25), depending on the criteria used. The mean age and diagnostic criteria of MetS were identified as sources of heterogeneity in the estimated odds ratios between studies (P<0.05). CONCLUSIONS: According to the high prevalence of MetS in RA patients, and high risk of MetS, measuring metabolic syndrome in RA patients is strongly recommended. Furthermore, as high waist circumference (WC) is the most common metabolic syndrome component, more attention must be paid to nutrition and weight loss among those with RA.

Determinants of Tobacco and Hookah Smoking in a Nationally Representative Sample of Iranian Children and Adolescents: The CASPIAN-IV Study.

BACKGROUND: The consumption of tobacco through a hookah is growing in popularity, especially among children and adolescents, but little is known about the determinants of hookah smoking. OBJECTIVES: The current study aimed to assess the determinants of tobacco smoking and hookah smoking in a nationally representative sample of Iranian children and adolescents. PATIENTS AND METHODS: This study was conducted as part of the fourth cross-sectional survey of a national school-based program. Using a cluster random sampling method, a validated questionnaire was completed anonymously by 14,880 students who were aged 6 - 18 years and living in urban and rural areas of 30 provinces in Iran. RESULTS: The final study group consisted of 13,486 children and adolescents (participation rate of 90.6%), of whom 49.2% were girls and 75.6% were urban residents. The mean age was 12.47 ± 3.36 years. According to the self-reports of the students, 2.6% (3.5% of boys and 1.7% of girls) were current tobacco smokers, 5.9% (7.5% of boys and 4.2% of girls) were ever tobacco smokers, and 1.8% (2.49% of boys and 1.14% of girls) were current hookah smokers. Based on a multiple logistic regression (MLR) model, the following factors increased the risk of current smoking: age, number of days spent with friends per week, hookah smoking or cigarette smoking by the father, hookah smoking by siblings, hookah smoking by other members of the family, and screen time. The age, number of days spent with friends, hookah or cigarette smoking by the father, hookah smoking by siblings, and screen time increased the risk of hookah smoking. Female gender and living in rural areas decreased the risk of current tobacco and hookah smoking. CONCLUSIONS: Preventive measures against tobacco use should be underscored for Iranian families. The preparation of strategies on the promotion of a healthy lifestyle should be considered a health priority.

Percentiles for anthropometric measures in Iranian children and adolescents: the CASPIAN-IV study.

BACKGROUND: The aim of the study was to provide the age- and sex-specific percentile values of anthropometric measures for Iranian children and adolescents. METHODS: This cross-sectional nationwide survey was conducted on a representative sample of 14,880 school students, selected by multistage random cluster sampling from urban and rural areas of 30 provinces in Iran. Anthropometric measures including body mass index (BMI), waist circumference (WC), hip circumference (HC), and wrist circumference were measured under standard protocols by using calibrated instruments. Age- and gender-specific reference values were developed for anthropometric measures by the maximum penalized likelihood approach [Cole's least mean square (LMS) method]. RESULTS: In the present study, 13,486 out of the 14,880 invited subjects completed all the required data of the study (participation rate: 90.6%). Participants consisted of 6640 girls (49.2%) and 75.6% urban residents; their mean and standard deviation (SD) age was 12.47±3.36 years. The BMI percentile curves of girls had a sharp increase from 14 to 18 years, and then began to plateau, but among boys, these curves had a consistent increase until the age of 18 years. In addition, the higher percentiles were higher in adolescent boys than girls. The HC percentile curves of both sexes had a persistent increase and the percentiles for HC were higher in adolescent girls than in boys. WC had a sharp increase from 7 to 18 years of age for boys, whereas for girls, these curves had a less sharp increase with age. In all ages, the percentiles for wrist circumference were higher in adolescent boys than girls. CONCLUSIONS: The findings of this study highlight the necessity of paying special attention to developing age- and gender-specific percentiles of anthropometric measures in children and adolescents.